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Stopping TB through social mobilization and community partnerships

Stopping TB through social mobilization and community partnerships. Lessons learned from FIGHT Project. Adhi Sanjaya Milton Amayun Sri Chander. Presented in 34 th Annual International Conference on Global Health and CCIH 2007 Annual Conference. REPUBLIC OF INDONESIA. EAST FLORES.

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Stopping TB through social mobilization and community partnerships

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  1. Stopping TB through social mobilization and community partnerships Lessons learned from FIGHT Project Adhi Sanjaya Milton Amayun Sri Chander Presented in 34th Annual International Conference on Global Health and CCIH 2007 Annual Conference

  2. REPUBLIC OF INDONESIA

  3. EAST FLORES ALOR MANGGARAI LEMBATA SIKKA NGADA ENDE TIMOR TENGAH UTARA (TTU) BELU WEST SUMBA TIMOR TENGAH SELATAN (TTS) KUPANG DISTRICT EAST SUMBA KUPANG CITY SABU ISLAND ROTE NDAO MAP OF NTT PROVINCE 2004

  4. NTP in NTT (2000) • Low Case Detection Rate • Low Cure Rate • Less coverage of DOTS service • Poorly trained health staff in NTP • High ratio of population per health staff • Weak collaboration between HCs (DOTS provider) and hospitals or private health provider • Low level of community involvement in health programs.

  5. FIGHT Project • Food integrated to hinder tuberculosis. • Funded by CIDA, March 2000 – Sept 2006. • Covers 5 districts, total population 1.1 M. • As a partner of government’s NTP. • Goal: “To contribute to the decrease of TB mortality and morbidity among people of NTT province”. • Work focus: district level.

  6. FIGHT Outcome Objectives • Improved and sustained quality DOTS TB program management • Increased participation and commitment of district government and TB DOTS implementers in TB control program • Enhanced community participation in improving a sustainable community-based TB control program

  7. Political commitment with increased and sustained financing Case detection through sputum smear microscopy examination Standardized treatment with supervision and patient support An effective drug supply and management system. M&E system and measurement DOTS implementation. Capacity building for health staff Community knowledge, skill and behavior Monitoring, supervision and evaluation Networking and advocacy Resources mobilization Food aid component (discontinued since April 05) Micronutrient research DOTS and FIGHT approaches

  8. Assisted areas 2000 to 2006

  9. Changes in district TB budget (US$)

  10. Case Notification Rate (xx/100,000)

  11. Sm+ cases detected (total 2,859)

  12. A TB patient’s profile: • Mostly poor • Low educated – did not finish elementary school • Low nutrition intake (only 922.4 Kcal / day) • Self medicates first with traditional medicine • Knows the disease can kill – but doesn’t know the treatment is FREE • Slow to seek health services (12 weeks delay from the first symptom)

  13. Dist Chief/LGU/Planning Dept HCs / Private Clinics NGOs, CBOs, FBOs, etc. Village Leadership Community/Self-Help Groups TB patient & family 13

  14. Village Midwives Mobile HC Sub HC Health Center

  15. Health Cadres Traditional leader Self-help groups Government officers Church Health Center

  16. NTT Governor Piet A. Tallo, is giving Category 1 TB drugs to a TB patient treated in Prof. Dr. W. Z. Johannes Provincial Hospital in Kupang, symbolizing the launching of Johannes DOTS Center on the National Health Day 12 November 2005.

  17. Some lessons learned from the field • Show them that you care! Benefits of home visits for treatment compliance and supervision – also for contact tracing. • Stress your rules! Patient signs letter of agreement to comply with the treatment regimen • Give testimonies! The most effective promotion is the one given by ex-TB patient

  18. Involve other parties • Obtain religious institutional support in TB treatment and case detection. • Invest in TB prevention in schools as public health investment for the future. Be creative and eye-catching. • Audio visual promotion method  more appealing to community.

  19. Using TB patient’s photos (by permission) as advocacy tool. • Identifying influential leaders  to help mobilize community and to improve participation.

  20. Don’t be afraid to change! Open and intensive communication  anticipate reaction to an unpopular decision. (eg. discontinuing the food aid and incentives). • Inappropriate knowledge about the disease  stigmas  hinders case finding, treatment and patient’s monitoring activity.

  21. Before After Ms. Esther Tabusan, 18 y.o.

  22. Mr. Urfinus Sa’u, 53 yo At the beginning And 7 months later…

  23. Terima kasih...

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